The following sample questions are similar to those on the examination but do not represent the full range of content or levels of difficulty.

To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the "Evaluate" button at the bottom of the page. A new browser window will open, displaying your results, which you may print, if you wish.

This practice exam is not timed, and you may take it as many times as you wish. Good luck!

First name: Last name:

1. A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to:

approve the patient for the elective surgery. obtain a kidney-urethra-bladder x-ray. obtain a renal arteriogram.obtain an abdominal ultrasound examination.

2. A patient whose history includes migraine headaches and a recent myocardial infarction derives the most benefit from taking which type of antihypertensive agents?

5. A 70-year-old woman who was admitted with cholecystitis is found to have a firm 2-cm swelling in the upper outer part of her right breast. The nurse practitioner's initial action is to:

advise the woman to follow up with her primary care physician. refer the woman for a surgical biopsy.send the woman for a mammogram. wait two months to see if it resolves.

6. The primary indicator of metabolic acidosis is a:

bicarbonate level of less than 20 mEq/L.change in pH and partial pressure of carbon dioxide (PaC02) in the same direction. change in pH and PaC02 in opposite directions. pH greater than 7.4.

7. While receiving chemotherapy for lung cancer, a patient becomes hypotensive and febrile to 104oF (40oC). A pulmonary artery catheter is inserted and reveals that the patient's cardiac output is 12 L/min and the pulmonary artery wedge pressure is 6 mm Hg. Based on these data, the nurse practitioner suspects which form of shock?

Cardiogenic Hypovolemic NeurogenicSeptic

8. A 60-year-old male patient, who has been hospitalized for an extended period after surgery, has not had his outpatient medications reordered. He complains of excruciating pain in the metatarsophalangeal joint of the right great toe. The diagnosis of acute gouty arthritis is confirmed by an elevated:

9. An acute care nurse practitioner is deciding whether to recommend that a patient follow a long-term medication regimen that will help control disease symptoms but may also create troublesome side effects. This decision involves consideration of which ethical principle?

AutonomyBeneficence Fidelity Non maleficence

10. Laboratory test results for a 78-year-old patient who is being evaluated for an aortic valve replacement, indicate a low serum albumin level. The patient is prescribed a high-protein diet. The acute care nurse practitioner can evaluate the patient's response with a:

12. A patient who had a left colectomy six days ago complains of vague abdominal discomfort on the right side of the abdomen. The patient's white blood count is elevated and the temperature is 38.9oC (102oF). The acute care nurse practitioner's most appropriate step is to:

obtain a chest x-ray. obtain a urine culture.obtain an abdominal ultrasound. order antipyretics.

13. An intervention aimed at reducing the risk of diabetic retinopathy is:

a total cholesterol of less than 220. an A1C test result of less than 9. photocoagulation by laser.tight control of hyperglycemia.

14. A 45-year-old patient who requires mechanical ventilation for acute respiratory distress syndrome (ARDS) develops purulent exudate in the right eye and conjunctival injection. Which is the most effective treatment?

16. A patient with a history of myasthenia gravis is admitted with left lower lobe pneumonia. The patient reports worsening of diplopia and dysphagia and more trouble breathing, over the past few days. To help the patient with the worsening symptoms of myasthenia gravis, the acute care nurse practitioner:

calls for a neurology consult, for advisement on adjusting doses of neostigmine (Prostigmin) and corticosteroids. orders an aminoglycoside, which is the drug of choice for treatment of pneumonia in a patient with myasthenia gravis. orders nerve conduction studies to guide treatment. prescribes dantrolene to minimize muscle spasticity.

17. For a patient with no history of polyps and no heritable risk factors, flexible sigmoidoscopy is recommended:

every 3 years starting at age 60.every 3-5 years after the age of 50. every 4-5 years after the age of 60. every 10 years starting at age 45.

18. A 55-year-old man comes to the clinic for his routine follow-up, after a successful autologous bone marrow transplant for multiple myeloma. The patient states he has a skin lesion that has changed in appearance. The acute care nurse practitioner responds by:

calling for a dermatology consultation to evaluate the lesion. inspecting and excising the lesion. prescribing a topical steroid preparation. recommending re-evaluation of the lesion in two weeks.

19. An intubated 56-year-old woman is in acute respiratory failure. The appropriate method of mechanical ventilation for this patient is:

22. An 83-year-old woman arrives in the emergency department in severe respiratory distress. The patient verbalizes a desire not to be intubated nor to have cardiopulmonary resuscitation performed. She states that a neighbor has a copy of her recently signed living will. The acute care nurse practitioner leaves the bedside momentarily and returns to find the physician preparing to intubate the patient. The nurse practitioner first:

assists the physician with intubation. calls the patient's neighbor to take a copy of the living will. locates an old hospital chart to find a copy of the living will.notifies the physician of the conversation with the patient.

23. A 24-year-old patient with a closed head injury has been intubated for 12 days. The patient's family has repeatedly refused consent for a tracheostomy and long-term care placement. The surgeon has discussed the risks and benefits of the surgery with the family, on multiple occasions. What is the best statement that the acute care nurse practitioner can verbalize to the family?

“I understand you have reservations about the placement of a tracheostomy.” “Not many patients have died while undergoing a tracheostomy.” “Without a tracheostomy, we cannot transfer this patient to another facility.” “You know, the patient will die if a tracheostomy is not placed.”

24. A woman who recently immigrated to the United States and speaks minimal English has signed a consent for a surgical procedure, after having the risks and benefits explained by the surgeon. The acute care nurse practitioner asks the patient to indicate her understanding but she is unable to answer because she speaks only minimal English. The nurse practitioner takes responsibility for ensuring that the patient has informed consent by:

asking the patient's husband, who speaks better English, to help to explain the information. explaining the information again to the patient, with gestures, and asking her to nod in understanding. notifying the hospital ethics committee that the patient is going to surgery without informed consent. providing the patient with a hospital translator to review the complete information, in the patient's language.

25. A 56-year-old man is seen in a clinic by the acute care nurse practitioner. The patient has a past medical history that is significant for hypertension, metabolic syndrome, and hyperlipidemia. A review of his symptoms indicate nocturia, occasional heartburn, and transient rhinitis. The patient asks about the appropriate interval of certain screening tests for someone his age. The nurse practitioner correctly answers that a:

digital prostate examination should be performed monthly. prostate-specific antigen (PSA) should be performed annually. sigmoidoscopy should be performed every 10 years. testicular examination should be performed every two years.____________________________________________________Acute Care Nurse Practitioner: Exam Sample QuestionsThis is a computer-based test (CBT).

The following sample questions are similar to those on the examination but do not represent the full range of content or levels of difficulty. The answers to the sample questions are provided after the last question.

To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the "Evaluate" button at the bottom of the page. A new browser window will open, displaying your results, which you may print, if you wish.

This practice exam is not timed, and you may take it as many times as you wish. Good luck!

First name: Last name:

1. To improve the health of a population, an acute care nurse practitioner's intervention is to:

join a professional nursing organization and run for an organizational office. maintain current certification as an acute care nurse practitioner. participate in hospital grand rounds.report any unusual pattern of infections to the local health department.

2. A patient, who is allergic to penicillin, requires antibiotic treatment for community-acquired pneumonia. The patient has a limited income, lacks health insurance, and is about to be discharged from the hospital. An acute care nurse practitioner's intervention is to:

consult social services for assistance. order an aerosol antibiotic. transfer the patient to an extended care facility. write a prescription for an antibiotic.

3. A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to:

4. Which musculoskeletal disease primarily involves the distal joints, hips, knees, and spine, and is characterized by the development of Heberden and Bouchard nodes?

Gout Osteoarthritis Osteoporosis Rheumatoid arthritis

5. An acute care nurse practitioner is deciding whether to recommend a long-term medication regimen that will help a patient manage disease symptoms but may also introduce problematic side effects. This decision reflects which ethical principle?

AutonomyBeneficence Fidelity Justice

6. A patient, who has been in the intensive care unit for 17 days, develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. An acute care nurse practitioner's initial treatment is to:

7. A 78-year-old male patient with heart failure develops a bacterial urinary tract infection secondary to an indwelling Foley catheter. The patient has a known history of allergy to penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is:

9. A 42-year-old patient with metastatic lung cancer is admitted with severe intractable pain related to a pathologic fracture of the left femur. The plan is to stabilize the fracture surgically, and begin local radiation therapy to the site. For this patient, the most appropriate analgesic regimen is:

fentanyl (Duragesic) transdermal system applied every 72 hours. meperidine (Demerol) 50 mg intramuscularly every three hours around the clock. morphine sulfate (Avinza) IV via a patient-controlled analgesia pump with a basal rate. oxycodone/acetaminophen (Percocet) orally every six hours around the clock.

10. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given information about her treatment regimen, expected side effects, and symptom management. Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute care nurse practitioner?

Alopecia FatigueFever Nausea

11. A patient with hydrocephalus secondary to a subarachnoid hemorrhage has developed an intracranial pressure of 25 mm Hg. The acute care nurse practitioner's intervention is to:

13. A 45-year-old patient, who is on mechanical ventilatory support in the intensive care unit, is receiving a neuromuscular blockade for respiratory control related to acute respiratory failure. To prevent keratoconjunctivitis sicca, the acute care nurse practitioner prescribes:

14. After undergoing a successful autologous bone marrow transplant for multiple myeloma, a 55-year-old male patient comes to the clinic for his followup appointment. The patient reports that a skin lesion has changed in appearance. The acute care nurse practitioner responds by:

consulting dermatology to evaluate the lesion. inspecting and excising the lesion. prescribing a topical steroid preparation. recommending reevaluation in two weeks.

15. An 83-year-old patient arrives in the emergency department in severe respiratory distress. The patient verbalizes a desire not to be intubated nor to have cardiopulmonary resuscitation performed. The patient states that a neighbor has a copy of the patient's recently signed living will. The acute care nurse practitioner leaves the bedside momentarily and returns to find the physician preparing to intubate. The nurse practitioner's initial action is to:

assist the physician with intubation. call the patient's neighbor to deliver a copy of the living will. locate a previous patient record to find a copy of the living will.notify the physician of the conversation with the patient.

16. A 24-year-old male patient with a closed head injury has been intubated for 12 days. The patient's parents have repeatedly refused consent for a tracheostomy and long-term care placement. On multiple occasions, the surgeon has discussed the risks and benefits of the surgery with them. Addressing the parents, the acute care nurse practitioner states:

“I understand you have reservations about the placement of a tracheostomy.” “Please know that not many patients die while undergoing a tracheostomy.” “Without a tracheostomy, we can't transfer your son to another facility.” “You know, your son will die if a tracheostomy is not placed.”

Discussing the medication choices with a collaborating physician Discussing the medication's side effects with a colleagueReviewing the confidence intervals of related research Reviewing the institutional formulary

18. During a clinic appointment, an acute care nurse practitioner sees a 56-year-old male patient with a history of hypertension, metabolic syndrome, and hyperlipidemia. A review of the patient's symptoms reveals nocturia, occasional heartburn, and transient rhinitis. The patient asks about the appropriate interval of certain screening tests for someone his age. The nurse practitioner responds that a:

digital prostate examination should be performed monthly.prostate-specific antigen should be performed annually. sigmoidoscopy should be performed every 10 years. testicular examination should be performed every two years.

19. Which is an accurate statement regarding the formal evaluation of quality of care?

20. While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship?

22. For an 84-year-old patient who undergoes surgery, the most accurate predictor of mortality and patient outcome is:

a low score on a Mini-Mental State Examination.an impaired functional status. the availability of social support. the patient's chronological age.

23. An acute care nurse practitioner performs a cardiac assessment on a patient with a confirmed mitral valve prolapse. During which activity does the nurse practitioner expect the patient's murmur to diminish?

Inhaling Sitting Squatting Standing

24. A 21-year-old patient is admitted to the intensive care unit with a severe closed head injury. The patient's family is becoming louder and more insistent about seeing the patient. To establish a therapeutic relationship with the family, an acute care nurse practitioner’s initial action is to:

acknowledge the family’s anxiety. arrange for a meeting with a social worker. escort the family to a conference room. gently direct the family to maintain composure.

A. vilectomy B. lungestomy C. chromactomy D. thoracotomy2. A treatment procedure that uses a pulling force to prevent or reduce muscle spasm, to keep a joint or other body part stationary, or to hold the ends of broken bones in place.

A. gravitation B. traction C. gerontation D. prostration3. The famous "Gifts to Physicians from Industry" guideline to provide ethical guidance for medical device companies interacting with physicians was written and adhered to by which industry associaton?

A. FDA B. HIPAA C. AMA D. PhRMA4. The are a couple of managed care concepts that a medical device sales rep should be aware of?